What’s turning women in labour away from hospitals?

Institutionalised delivery is encouraged as a means of reducing maternal/infant mortality, but the misbehaviour meted to pregnant women in government hospitals deters them, and others who hear of their experiences, from seeking such care. Ruhi Kandhari reports.

The birth of the first baby should be an occasion for celebration but Sama Parveen's memory of her first delivery is a sad one. This 21-year-old, who lives with her husband in a one-room tenement on the banks of River Yamuna in north-east Delhi, has been married for two years. Learning that Parveen was pregnant, the local Accredited Social Health Activist (ASHA) convinced her about the benefits of a hospital delivery, as opposed to calling a traditional midwife at home.

Taking her advice, Parveen found herself scared, alone and with very little money in hand, outside the gates of Guru Teg Bahadur Hospital in the trans-Yamuna area on 2 July 2013. That was when she got her first shock – the guard stopped her.

“The baby was half out as I was entering the gate but the guard asked me for Rs 1,000 and made it clear that I would not be allowed in until I paid up,” Praveen narrates between sobs.

Finally, Parveen entered the hospital and passed out on a bench. She remembers waking up to the shouts of a nurse. “I was feeling weak and sleepy. The nurse slapped me twice, on my face and thighs, and asked if I had come there to sleep,” Parveen recalls, still traumatised by the memory. “Later, when my daughter was delivered, they demanded Rs 500 to even cut the umbilical cord.”

Today, Parveen is certain she will never submit herself to such treatment again. As for the women in the neighbourhood who have heard her story, they too are full of trepidation about seeking maternal health care in a government hospital.

GTB Hospital happens to be the capital’s first government tertiary care hospital catering primarily to the eastern Delhi population. But stories of physical and verbal abuse and avaricious hospital staff on the constant lookout for palm grease are a legion here. Any couple sitting with their newborn on the lawns of this hospital could relate such a story, and it is precisely such experiences that deter families from seeking institutional deliveries.

There are innumerable lags that mark the functioning of government hospitals in the country. Researchers and health activists have pointed to concerns over poor accessibility, high costs and the lack of adequate health infrastructure and staff. What, however, remains largely under-reported is the widespread maltreatment accorded to patients.

Take Nisha Parveen and Zeenat Ansari, both of whom delivered babies over the last year in GTB Hospital. Neither of the women want their friends or relatives to go through what they had experienced. According to Nisha, when patients screamed in pain during childbirth the doctors attending on them often hit them.

Zeenat concurs, “I felt really afraid while watching the treatment accorded to patients there. Some of them were hit really hard on the thighs.”

Zeenat also observes that her husband ended up paying almost as much as he would have spent if they had gone to a private maternity clinic. In all, the couple spent Rs 6,000 for a week’s stay in hospital after she had undergone a Caesarean operation. What struck her most was the fact that the hospital staff – from the guard to the cleaner – would demand money every time her husband came to visit her.

Pinki was pregnant with her third child when she learnt about Zeenat’s experiences. She had already experienced the callous manner in which medical personnel handled patients, having once been ordered out of the room by a doctor when she had gone for a check-up. “So, for my third delivery, I touched the feet of my parents-in-law and pleaded with them not to send me to a government hospital,” she says.

Pinki’s husband and father-in-law borrowed money and she was able to give birth to her baby girl in the relative comfort of a private health clinic which charged her Rs 6,000.

While Pinki’s delivery was normal and her family would be able to repay its debt, Usha Devi’s case took an unfortunate turn. She was admitted to the government-run Jag Pravesh Chandra Hospital, a general secondary level hospital in north-east Delhi, with complications related to her pregnancy. Not only was she intimidated by the rude behaviour of the hospital staff, she was traumatised by the deaths of a mother and her newborn baby that she happened to witness.

A specialised neo-natal facility like this one is not very common to find in government hospitals in India. Pic: WFS

“I was very scared listening to the cries of all the women in the ward in the throes of labour pain and listening to nurses talk to them so rudely. The woman that I was sharing my bed with had just delivered a baby boy – both the woman and the child died before my eyes. My head started spinning after this and I told my husband I could not stand being there. So we just walked out of the hospital,” recalls Usha Devi.

Her husband, who plies a rickshaw to earn a living, then took her to a private hospital where her baby was delivered through a Caesarean section. But it entailed a hospital stay of four days and a debt of Rs 50,000.

While some families borrow money to get private health care, others opt for home births. According to Rajkumari, an ASHA based in Delhi, sending patients to the hospital is sometimes counterproductive. “It is so difficult to convince women to go to hospitals for their checkups and many of them are so discouraged by their experiences in these facilities, they end up delivering at home.”

According to a large number of ASHAs spoken to, rude behaviour and physical abuse are major factors that deter women from seeking institutional deliveries.

Kanta, a Delhi-based ASHA, narrates an incident that happened when she took a patient to the hospital for her first delivery, “When I went to her for her second pregnancy, she firmly refused to go to the hospital, saying that she was treated extremely badly on the earlier occasion and had decided to opt for a home delivery.”

According to Sama, another ASHA, women were not ready to go to hospitals because the behaviour of doctors was uniformly bad in all government facilities. “They speak to their patients in such an abusive way, hit them sometimes and turn them away even when the patient is in labour. We have had cases of patients delivering on the road or outside the hospital,” she says.

Institutional deliveries have been regarded as the panacea to address India’s high levels of infant and maternal mortality, but unless something is done to make the experience a happier one for ordinary women, nothing will change.

Kerry Mcbroom, Director of the Reproductive Rights Unit at the Human Rights Law Network, observes that “The whole system is designed to lure women into institutional delivery but it is not equipped for it, creating barriers to institutional deliveries in the process.”

Among these barriers is the reality of abuse targeted at patients, although it is not recognised widely enough. As Mcbroom puts it, “Bad behaviour of the staff is common across the country. Government hospitals are understaffed and personnel here work under difficult conditions. Not only are they not trained adequately, they are overburdened and work for long hours without proper support.”

It’s time India’s health administrators recognised the problem and addressed it urgently.

Ruhi Kandhari18 February 2015

The author is an independent journalist who has reported on social, economic and environmental policy issues for numerous publications. This article has been published in arrangement with the Women's Feature Service.